Provider Demographics
NPI:1861130551
Name:PATEL, MUDRA KUNTAL
Entity type:Individual
Prefix:
First Name:MUDRA
Middle Name:KUNTAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W 54TH ST
Mailing Address - Street 2:#404
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-496-1187
Mailing Address - Fax:
Practice Address - Street 1:244 W 54TH ST
Practice Address - Street 2:#404
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-496-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046891-01208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation